Relationships among Depression, Depressive Symptom Dimensions, and Acculturation in Latino Adults with Type 2 Diabetes

Abstract

Relationships among Depression, Depressive Symptom Dimensions, and Acculturation in Latino Adults with Type 2 Diabetes Background: The co-occurrence of diabetes and depression is associated with poor diabetes self-management and worse health outcomes. Latinos with type 2 diabetes are less likely to be diagnosed or to receive care for depression. This study hypothesized that Latinos would report significantly more somatic-affective symptoms of depression than non-Latinos. Depression differences among distinct Latino nation of origin groups were examined. Participants of Puerto Rican background were expected to demonstrate the highest levels of depression severity and people of Mexican background would demonstrate the lowest severity. It was hypothesized that Latino acculturation would be positively associated with total, somatic- and cognitive-affective depression scores.

Methods: This dissertation examined Bronx Alc study data (Walker et al., 2014), which involved 941 economically disadvantaged, ethnic minority adults living with type 2 diabetes. Over 67% of the sample was Latino and 28% was non-Latino black. At baseline and prior to receipt of any intervention, participants completed a validated self-report measure of symptoms of major depressive disorder (PHQ-8) from which depression scores were derived. Acculturation was measured according to a culturally specific standardized measure (SASH), nativity and language preference.

Results: Analysis of covariance models demonstrated that Latinos reported significantly more somatic- (F(1,760) = 6.32,p = .012, np2 = .01) and cognitive-affective symptoms of depression (F(1,766) = 10.29,p = .001, np2 = .01) compared to their non-Latino counterparts. These differences were equivalent across the symptom dimensions, contrary to expectations. Nation of origin was significantly associated with variation in somatic-affective depressive symptoms (F(4, 444) = 2.47, p = .04). Pairwise comparisons showed that people of Puerto Rican background had significantly higher scores on the somatic-affective depressive dimension compared to people of Mexican and Dominican background. Neither the SASH nor proxy variables for acculturation were related to depression symptom severity among Latinos.

Conclusions: Distinguishing somatic- and cognitive-affective depression from total depression did not explain Walker et al.'s (2014) finding of 21% higher total depression scores among Latino participants. People of Puerto Rican background endorsed significantly more symptoms of depression than participants of Mexican and Dominican background. Acculturation did not appear to play a role in these differences.